Recommended
Recommended
More Related Content
Similar to Comics in mental health training by Anthony Farthing and Ernesto Priego
Similar to Comics in mental health training by Anthony Farthing and Ernesto Priego (20)
Recently uploaded
Recently uploaded (20)
Comics in mental health training by Anthony Farthing and Ernesto Priego
- 1. Stripped of their powers? The use of comics as information resources in mental-health training Anthony Farthing @AnthonyFarthing The Tavistock and Portman NHS Foundation Trust Ernesto Priego @ernestopriego City University London Graphic Medicine 2016: Stages & Pages 9th July 2016, Dalhousie Building, University of Dundee, Scotland #GraphicMedicine #StagesPages
- 2. Licence With the exception of third-party content, this deck of slides and its presenters’ notes are licensed under a Creative Commons Attribution 4.0 International Licence Images included in this presentation are copyright their respective authors.
- 3. Case study The Tavistock and Portman NHS Foundation Trust Excerpt from Billy, Me & You © Nicola Streeten, 2011 Specialist centre for training and treatment in mental health and social care 2000 students a year on courses from short CPD to clinical doctorates Data gathered from the Trust’s Library and Information Service Related research: Farthing and Priego (2016) ‘Graphic Medicine’ as a Mental Health Information Resource: Insights from Comics Producers http://www.comicsgrid.com/articles/10.16995/cg.74/
- 4. Research questions How do students and tutors at the Trust view comics as an information resource? Are comics being used in teaching at the Trust? Should the Trust’s Library and Information Service be providing more comics? The only comic in the library collection Couch Fiction by Philippa Perry and Junko Graat (Palgrave Macmillan)
- 5. Use of comics at the Trust Total sample 108 Gender Female: 82% Male: 17% Other: 1% Roles Students: 84% Tutor/Lecturers: 8% Clinical staff: 7% Demographics of library survey sample
- 6. Experience and attitudes towards comics Yes No Don’t know Have you read any graphic novels, comic books or website comics for leisure in the past five years? 31% 67% 2% Would you feel comfortable using graphic novels, comic books or website comics as study or teaching materials for higher education? 46% 29% 25% Would you consider using graphic novels, comic books or website comics as part of a class or professional presentation? 58% 23% 19% Responses from library survey
- 7. Analysis of survey responses by comics experience
- 8. Analysis of survey responses by age
- 9. Analysis of survey responses by gender
- 10. Students rating potential uses of comics Online questionnaire completed by 15 students at the Trust
- 11. Students’ responses to positive statements on use of comics
- 12. Students’ responses to negative statements on use of comics
- 13. Interviews with clinical staff How comics are used by staff ● comic strips (eg, Calvin and Hobbes, Nemi) used in PowerPoint presentations during lectures/training ● drawing exercises used in therapy includes comics elements to understand emotions and situations (eg, thought bubbles, sequencing of events) And by patients... ● ‘disturbed children will be superheroes… but their version is often different’ ● The Beano used by a patient to hide from therapist Four clinicians interviewed 1. Consultant child/adolescent psychiatrist 2. Child psychotherapist/supervisor 3. Clinical psychologist in gender identity 4. Consultant clinical psychologist in specialist education/consultancy work ● 2 male/2 female ● All conduct some training ● All read comics as children - Clinicians 3 and 4 had read comics/graphic novels as adults (eg, Maus)
- 14. Clinical staff views on comics Potential obstacles ● ‘wouldn’t use as therapy with adolescents and young adults into mid-20s... they are capable of verbal interactions and conversations’ ● ‘something becomes so satirical, if not mocking, that it might demean or degrade the message’ ● ‘a comic is already someone else’s unconscious’ ● ‘kids’ comic and picture books… they’re very gender-stereotypical’ ● ‘don’t know what resources there are out there’ Potential utility ● ‘reaching young men aged 18-25’ ● ‘an idiom that might mean something to students who are going to be coming through at younger ages’ ● ‘with younger observers, you might well want to start with something more immediate like a comic strip’ ● ‘gives a bit of space allows reflection in a way that’s different from a photo’ ● ‘capture a whole scene, the dynamic and interaction between people’
- 15. How do students and tutors perceive comics as an information resource? ● Comics linked with younger age groups by students and staff ● Some gender bias – higher percentage of males feel comfortable about comics use ● Indicators that comics could be a potential tool – 80% disagreement that comics can’t be used in an academia, positive responses about comics exploring social issues ● Uncertainty about how to quote or cite comics – students unsure how they’re viewed as sources by tutors
- 16. Are comics being used for training at the Trust? ● Limited use of comic strips as illustrations in training presentations ● Comics mechanisms used in some therapeutic drawing exercises ● Cultural associations used in therapeutic settings – eg, clinical narratives about comic book characters such as superheroes
- 17. Should the Trust’s library be providing more comics? ● Uncertainty among the staff and student populations about the deeper value of comics ● Encouraging use of the library comics collection during the period of research ● Survey found that respondents were more comfortable with using comics academically if they’d had recent experience of reading them
- 18. Thank you!
- 19. References Image credits ● Bender, L. and Lourie, R. S. (1941) The effect of comic books on the ideology of children. American Journal of Orthopsychiatry, 11(3), 540-550. ● Bolton-Gary, C. (2012) Connecting through comics: expanding opportunities for teaching and learning. US-China Education Review B, 2(1), 389-395. Available: http://www.davidpublishing.com/show.html?6160 [5 July 2016] ● Green, M. J. and Myers, K. R. (2010) Graphic medicine: use of comics in medical education and patient care. BMJ, 340, 574- 577. ● McCloud, S. (1993) Understanding Comics: The Invisible Art. Northampton, MA: Kitchen Sink Press. ● Rubin, L. C. (2005) Superheroes and heroic journeys: Re-claiming loss in adoption. Journal of Creativity in Mental Health, 1(3/4), 237-252. ● Sarfati, Y., Hardy-Baylé, M. C., Besche, C. and Widlöcher, D. (1997) Attribution of intentions to others in people with schizophrenia: a non-verbal exploration with comic strips. Schizophrenia Research, 25(3), 199-209. ● Williams, I. (2011) Autography as auto-therapy: psychic pain and the graphic memoir. Journal of Medical Humanities, 32(4), 353-366. ● Williams, I. (2012) Graphic medicine: comics as medical narrative. Medical Humanities, 38(1), 21-27. ● Slide 2: Statue of Freud at the Tavistock Clinic. Photograph by Mike Peel (www.mikepeel.net). Licence: CC-BY-SA-4.0. ● Slide 2: Excerpt from Billy, Me & You, by Nicola Streeten. Brighton: Myriad Editions. © Nicola Streeten, 2011 ● Slide 3: Cover image from Couch Fiction by Philippa Perry and Junko Graat. Basingstoke: Palgrave Macmillan. © Philippa Perry and Junko Graat, 2010 ● Slide 17: The Tavistock and Portman NHS Foundation Trust Library and Information Service. CC-BY-4.0
Editor's Notes
- This presentation explores the use of comics as an information resource in the areas of mental health and social care training. We’ll analyse the perception of comics at The Tavistock and Portman NHS Foundation Trust in North London, UK, presenting original data collected through the Trust’s Library and Information Service.
- Our case study… The Tavistock and Portman Trust specialises in mental health and social care and is a centre for both treatment and training. The majority of the Trust’s clinical work is focussed on treating children, although adult therapies are available, as is shown in Billy, Me & You by Nicola Streeten – there’s an excerpt from this in the top left of this slide that mentions the Tavistock Clinic. The library itself is open to staff and students at the Trust, with its collection mainly tailored to the needs of the academic population. Note: We have published a related research article that explores the production processes of mental-health related comics from the perspective of producers and distributors. There’s a link on the bottom of this slide.
- To answer our research questions, we used a mixed-method approach to produce qualitative and quantitative data, and all data was generated between October and December 2014. Collection of all data complied with the requirements of City University London’s Research Ethics Committee. Informed consent was obtained and no sensitive information was collected. We tested attitudes toward comics among staff and students at the Trust using empirical studies in the form of a survey and follow-up questionnaire, plus semi-structured interviews with four clinicians working there. In seeking comics material to explore, we make use of McCloud’s definition of comics as: ‘juxtaposed pictorial and other images in deliberate sequence, intended to convey information and/or to produce an aesthetic response in the viewer’ (McCloud 1993: 9). This was helpful in establishing what type of comics material was already held in the library collection before the start of this project – several illustrated books were found, but only one item corresponded with this definition of comics: Couch Fiction by Perry and Graat (2010). Examining the literature, examples of the therapeutic uses of comics were found, especially involving children. In 1941, Bender and Lourie discussed three children’s neurotic episodes or negative behaviour and concluded that comics can function ‘as a means of helping them solve the individual and sociological problems appropriate to their own lives’ (Bender and Lourie, 1941, p. 550). The powers of comic-book characters, especially superheroes, are invoked as ways of reaching traumatised children (Rubin, 2005). And the mechanics of comics creation are utilised by Comics Strip Conversations (Gray, 1994) – a technique that incorporates simple strips to help people with autism and Asperger syndrome understand social interaction. Similarly, comic strips have been used to examine and improve social-cognition in patients with schizophrenia (Sarfati et al., 1997). Beyond any proposed therapeutic utility, Bolton-Gary (2012, p. 394) found that comics in teaching helped create ‘a positive affective context’ in a study of an Introduction to Psychology course in a US university. The author also lists a range of educational psychology texts that use strips such as Calvin and Hobbes, Doonesbury, and Peanuts to convey ideas, claiming they go beyond affective purposes and ‘are also engaging higher level language modalities’ (Bolton-Gary, 2012, p. 391). Ian Williams (2011) and Green and Myers (2010) propose graphic illness memoirs have an ability to provide ‘new insights into the personal experience of illness’ (Green and Myers, 2010, p. 574). So as Williams suggests, an educational use of these would then be as a way to ‘help healthcare workers understand the nature of personal narrative and hence may lead to a more considerate and enlightened attitude when dealing with the patient’s history’ (Williams, 2012, p. 26). Essential in mental health and social care.
- No evidence could be found of comics being adopted as course material at the Trust, so while our research would try to discover any current use of comics by students or staff, it would also try to measure the potential for use by exploring attitudes. We set up an online survey and promoted it using the library website and on Moodle – and there was an incentive prize draw. We also added a collection of mental health related comics, purchased by us during research for this project, to the library’s catalogue to temporarily expand the comics on offer at the Trust. So we’ll first be presenting data from the 108 respondents who either identified themselves as students, tutors/lecturers or clinical staff. I hope you can all read this slide. The representations of gender and age ranges are not typical for a UK higher-education setting, but the figures are consistent with the general demographic of the academic population at the Trust.
- To establish the respondents’ comics experience, they were asked if they’d read any graphic novels, comic books or website comics for leisure in the past five years. They were then asked if they would feel comfortable using graphic novels, comic books or website comics as study or teaching materials for higher education. They were also asked if they would consider using graphic novels, comic books or website comics as part of a class or professional presentation?
- We conducted an analysis on the responses to the question about the academic use of comics, to see if trends were different in individuals with more recent comics experience. On the left of this graph, you can see that of those who had read a comic in the past five years, 68% said they would feel comfortable using comics for academic work much higher than the 36% for those who hadn’t.
- We also analysed by age (the youngest age group, 18-24 years, had to be omitted as there were only two respondents in this category). The age group with the highest percentage of ‘yes’ responses were 55-64 years (53%) but all groups had more Yes responses than No responses.
- We also analysed by gender – 61% of male respondents indicated they would feel comfortable using comics, compared to 44% of female respondents.
- We’ll now move on to the next stage of data collection: the student questionnaire. During the online survey of library users, participants were asked to indicate whether they’d like to help with further research and 21 students volunteered. These were all sent an online questionnaire and 15 completed it. The gender distribution was close to the first survey, with 80% of student-questionnaire respondents being female, and 20% male. The age distribution was also similar: the biggest age group being the 25-34 group with 33% of respondents, although none of the respondents to the student questionnaire were in the 65 and over age group. Similar levels of recent comics experience were evident, with 33% of participants in the student questionnaire having stated they had read comics in the past five years. However, when it came to the question on whether they’d feel comfortable using comics for study, 60% of this sample had responded yes, which is considerably higher than the 44% of all the respondents in the original library user survey. The table on screen, shows the results of the students being asked to rate 10 potential uses of comics with a score on a scale from one to five – the score of 1 representing ‘not useful’ to 5 representing ‘very useful’. The results are ranked by mean rating and all but one of the suggested uses of comics (to practice observational skills) had more scores in the upper two categories (so the ‘useful end) than the lower two (the ‘not useful’ end).
- Next, we presented the students with a matrix of multiple-choice Likert-type items. They were asked ‘To what extent do you agree or disagree with the following statements?’ and were presented with a mixture of statements with positive outcomes and negative outcomes. These are the responses to the positive statements. On this slide, going from left to right… High level agreement and no disagreement with the statements ‘Combining images and text to convey information helps me remember it’ and ‘Comics can be used to explore serious social issues’. There’s far less agreement and a lot more uncertainty for the other two statements ‘Using comics in some parts of my course would make it more interesting or enjoyable’ and ‘My tutor would react positively to me using a comic book for an assignment’.
- On this slide, we have the responses to negative Likert-type statements. Starting from the left, there’s high levels of disagreement with the statements ‘Comics are only meant to be read by children or teenagers’ and ‘I wouldn’t want my fellow students to see me reading a comic’. There’s a 53% neutral response to the statement ‘The layout of images in comics can be difficult to follow’. But there’s a high level of agreement for ‘I don’t know how to cite or quote a comic book in an academic assignment’ and no neutrality. The column on the far right shows the high levels of disagreement for the statement ‘It's inappropriate to deliver academic information using comics’ with 87% choosing either strongly disagree or disagree.
- To explore the attitudes of Trust staff towards comics, we conducted four semi-structured interviews and it should be noted that the two male participants were initially approached because they were considered by library colleagues as being potentially interested in this type of research project (although neither had requested any comics material as far as could be remembered). The other two participants agreed to being interviewed after being purposively requested. The four participants primarily describe their role as clinicians, but all are involved with training to some extent We won’t be using their names and exact ages today, but their roles are: Clinician 1 Consultant child/adolescent psychiatrist, male Clinician 2 Child psychotherapist/supervisor, female Clinician 3 Clinical psychologist in gender identity, female Clinician 4 Consultant clinical psychologist in specialist education/consultancy work, male All the participants recalled reading comics as children. When it came to reading comics as an adult, Clinician 3 said she had read ‘maybe a couple of graphic novels – two or three’ but was unable to remember the titles. Clinician 4 recalled reading Maus and Calvin and Hobbes with his children. All four clinicians reported occasional use of comic strips in PowerPoint presentations, including Nemi and Calvin and Hobbes. The clinicians who worked with younger children all reported using drawing during therapeutic sessions. Clinician 4 recalled creating illustrations in speech and language therapy with ‘the idea of constructing a comic strip where you have basic characters… speaking to each other.’ He also mentioned using drawing to help children describe problematic events, helping them to illustrate ‘what’s going on before, what the consequences are afterwards, what the loop might be for contextual factors’. Clinician 2 mentioned that children will sometimes bring comics into a therapeutic session and they can become a talking point – but they can also become a barrier and she gave this example: ‘I’ve got one supervisee at the moment, [her patient] uses The Beano like a shield and occasionally she hears “Hah!” or laughter behind... he’s definitely shutting her out…’ She also mentioned that comic-book characters can appear in the child’s narrative during therapy: ‘A lot of very disturbed children will be superheroes… but their version [of the character] is often really different.’
- Potential utility Both clinically and in terms of training, Clinician 1 wondered whether the comics format might be more suitable for younger demographics and he speculated that ‘...if this is an idiom that might mean something to students who are going to be coming through at younger ages than I am, it is something to consider”’ He also noted that ‘largely in health, and particularly mental health, reaching young men aged 18-25 is a gap in any service – would they respond better if there was something in Manga or a graphic novel that resonated with their world?’ Clinician 2 discussed the possibility of using visual material to introduce students to the development of observation skills, but did seem to link the idea with younger demographics. She said: ‘You could do a comic strip equally well and I don’t think it matters what it is… So especially these days... with younger observers, you might well want to start with something more immediate like a comic strip’. Despite his not using comics therapeutically, Clinician 1 did identify how some of the inherent features of comics could be useful. He said: ‘The advantage of comics as well is, when you see an image of a person, you have all sorts of associations to that, which would be quite immediate. When you are taking it to a largely two-dimensional world, and portraying it in a more linear way, it gives a bit of space allows reflection in a way that’s different from a photo’. He also stated ‘You’ve got multiple speech bubbles, so people are able to communicate simultaneously and that might express something about the atmosphere and interactions’. Potential obstacles Clinician 1 didn’t think visual materials would be useful for him in therapeutic sessions because ‘I tend to work with adolescents and young adults into mid-20s and I think they are capable really of verbal interactions and conversations’. During the interview he also questioned whether the term ‘comics’ could be problematic: ‘it makes one ask where does caricature and humour sit in these? Now you could get a certain point across using that, but I guess one would have to be cautious about whether something becomes so satirical, if not mocking, that it might demean or degrade the message’. Therapists introducing comics in a session was seen as potentially problematic for Clinician 2. She said: ‘A comic is already someone else’s unconscious, so you’ve then got their images and you can get the imitations [in the patient].’ But she emphasised this is different from when patients bring in comics. Clinician 3 sees problems in using comics in her work on gender identity: ‘They’re very gender-stereotypical and so that puts me off a bit’. She did wonder, though, if there might be more suitable comics available: ‘I think it’s more that I don’t know what resources there are out there. I would use them if I knew that they were relevant resources. I wouldn’t know how to find them’.
- There is evidence of some cultural assumptions. The connection of comics to childhood is apparent but, given that much of the focus for training and treatment at the Trust centres around working therapeutically with children, it is perhaps no surprise to find that potential link in the data for this project. From the students, this was exemplified in their rating the use of comics in therapeutic work with children as the most useful potential function, while placing using comics in therapeutic work with adults near the bottom of the list. Although this is somewhat contradicted by 80% of students disagreeing with the statement ‘Comics are only meant to be read by children or teenagers’. Two clinicians also suggested that comics material might be more suited to younger students at the Trust, although it was the 55-64 age group in the library user survey that had the highest number of respondents who would feel comfortable about using comics. This suggests increasing age wouldn’t necessarily be a barrier to their use among the academic population. When examining the male and female samples of the library user survey, a higher percentage of male respondents (67%) were comfortable using comics academically, revealing gender as a possible factor in perception. There does seem to be a lack of confidence around using comics academically. This is reflected by the high levels of agreement by students to the statement ‘I don’t know how to cite or quote a comic book in an academic assignment’. The were also unsure how their tutors would receive them using comics as sources. However, there were indicators that comics could be used as a learning tool – for example, the high levels of disagreement that comics can’t be used in academia.
- There was some limited use of comic strips in educational presentations by staff. The mechanisms of comics were also shown to be used in some therapeutic situations. However, perhaps because of apparent reservations about any deeper value, there was no evidence of the extended study of any comics material.
- As library and information professionals, Ernesto and I are convinced that comics are potentially powerful tools for learning and their uses should be explored further. There is uncertainty at the Trust over their deeper utility and there are some potentially unhelpful perceptions and preconceptions of comics. However, usage of the comics collection during the research period was encouraging, with a total of 32 loans made from it over the three months. And as was shown by the library survey, respondents were more comfortable with using comics academically if they’d had recent experience of reading them, so we feel it’s important that more people have the opportunity to use this type of material. And perhaps to finally answer this last question... at the end of the research project, the head of the Library and Information Service decided that comics should be part of the library provision policy and the temporary collection is now permanent.
- Here it is, and we’ll be adding to it in the future, so if you have any recommendations, let us know!